MEDICARE: MRS. MARIA LUZ TABBAKH M.S.N., C.N.S-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SA2200X	Adult Health Clinical Nurse Specialist	15835-NS	OH

General Provider Information

NPI Number	:	1053432161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIA LUZ TABBAKH M.S.N., C.N.S-BC

Provider Business Mailing Address
First Line	:	545 MOORLAND DR
Second Line	:
City	:	GROSSE POINTE WOODS
State	:	MI
Zip	:	48236-1182
Country	:	US
Telephone Number	:	313-469-7418
Fax Number	:

Provider Business Practice Location Address
First Line	:	20050 HARVARD AVE STE 207
Second Line	:	CLEVELAND CLINIC PAIN MANAGEMENT
City	:	WARRENSVILLE HEIGHTS
State	:	OH
Zip	:	44122-6800
Country	:	US
Telephone Number	:	313-516-9554
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	06/27/2014

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